[Quality of life in antihypertensive therapy]

It is well known that distinct antihypertensive drugs have a different impact on compliance and on quality of life of patients. Therefore, we must ask under what conditions a refusal of antihypertensive medication can be justified and what its consequences are with regard to cardiovascular morbidity and mortality. An aspect of this latter question is answered by a prospective study on cardiovascular risks in a cohort of 416 middle-aged male blue-collar workers followed over three years: In the subgroup of 94 workers with mild or manifest hypertension few aspects of quality of life only were improved in the untreated (54%) as compared to the treated (46%) hypertensives. On the other hand, longterm cardiovascular risk was considerable: every third worker with untreated mild hypertension (140 to 160/90 to 100 mmHg; n = 30) exhibited signs of early left ventricular hypertrophy, as assessed by one- and two-dimensional echocardiography. The most impressive difference was found with regard to the diameter of left atrium (T = 3.02; p less than .01). The second part of the paper presents first results of a test-statistical evaluation: a German version of a well known measurement approach to quality of life in the United States is applied in 50 hypertensives and 56 normotensives. Internal consistency, stability and discriminant power of the questionnaire were very satisfying. Hypertensives compared to normotensives and treated hypertensives compared to untreated hypertensives showed significant differences on several subscales (esp. "general wellbeing", "vitality"). Results indicate that this measurement approach can be reliably used in further studies.